Benefits and harms associated with an increase in gestational diabetes diagnosis in Queensland, Australia: a retrospective cohort comparison of diagnosis rates, outcomes, interventions and medication use for two periods, 2011-2013 and 2016-2018, using a large perinatal database

Trends in the use of induction of labor by methods and indications: A population-based study

INTRODUCTION

Induction of labor is a widely used obstetric intervention, with rates increasing globally. In Australia in 2022, over one-third of women gave birth following the induction of labor. Though the rate of induction has increased, changes in methods and indications for induction have not been analyzed for the state of Victoria. This study aims to analyze these trends in Victoria, Australia.

MATERIAL AND METHODS

A retrospective cohort study was conducted using de-identified data from the Victorian Perinatal Data Collection (VPDC) that includes all births statewide of at least 28 completed weeks' gestation from 2012 to 2020. The study analyzed trends in the onset of labor, methods used, and indications for induction over the study period, using descriptive statistics and average annual percentage change.

RESULTS

A total of 701 324 births occurred during the study period, of which 223 672 (31.9%) were inductions. Induction of labor rates increased significantly from 25.4% in 2012 to 37.7% in 2020, with a notable rise at 38 and 39 weeks' gestation. Significant changes were observed in induction methods-the use of combination methods, particularly balloon catheter followed by pharmacological agents, increased, while the use of a standalone method declined. The findings suggest that gestational diabetes and fetal indications were major drivers of induction in recent years.

CONCLUSIONS

Labor induction practices in Victoria have changed significantly, reflecting shifts in clinical practices and changes in health profiles of pregnant women. Further research is needed to investigate the rising use of induction at early term gestation and the role of maternal preferences in driving induction in Victoria.

Improving maternal and neonatal outcomes for women with gestational diabetes through continuity of midwifery care: A cross-sectional study

PROBLEM

Gestational Diabetes Mellitus (GDM) is a complication of pregnancy which may exclude women from midwife-led models of care.

BACKGROUND

There is a paucity of research evaluating the safety and feasibility of continuity of midwifery care (CoMC) for women with GDM.

AIM

To investigate the impact of CoMC on maternal and neonatal outcomes, for otherwise low-risk women with GDM.

METHODS

This exploratory cross-sectional study observed maternal and neonatal outcomes including onset of labour, augmentation, labour analgesia, mode of birth, perineal trauma, gestation at birth, shoulder dystocia, infant birth weight, neonatal feeding at discharge.

FINDINGS

Participants were 287 otherwise low-risk pregnant women, who developed GDM, and either received CoMC (n=36) or standard hospital maternity care (non-CoMC) (n=251). Women with GDM who received CoMC were significantly more likely to experience an spontaneous onset of labour (OR 6.3; 95% CI 2.7-14.5; p<.001), labour without an epidural (OR 4.2; 95% CI 2.0 - 9.2,<0.001) and exclusively breastfeed (OR 4.3; 95% CI 1.26 - 14.32; p=0.02).

DISCUSSION

Receiving CoMC may be a public health initiative which not only improves maternal and neonatal outcomes, but also long-term morbidity associated with GDM.

CONCLUSION

Findings provide preliminary evidence suggesting CoMC improves maternal and neonatal outcomes and is likely a safe and viable option for otherwise low-risk women with GDM. Larger studies are recommended to confirm findings and explore the full impact of CoMC for women with GDM.